Transversal Double-Level Mandibular Distraction by Basal Bone Hinge Anchorage and Dentoalveolar Acrylic Plate for a...

Transverse mandibular deficit is characterized by dental crowding, retroalveolism, and vertical dystopia of the anterior alveolar process. Traditional treatments can cause periodontal, occlusion, and esthetic complications. Distraction osteogenesis represents a technique for enlarging bone segments and promoting the formation of regenerated bone that, after maturation, may show characteristics comparable to native bone, as reported in the literature. The study presents an evolution of a previously described technique, in which dentoalveolar distraction is achieved in a curvilinear shape that matches the natural morphology of the alveolar bone. The patient presented with severe dental arches crowding and a nasal breathing impairment. The surgical approach involved an incomplete Le Fort I osteotomy and the insertion of a hybrid distractor with four orthodontic bands for dental anchorage and four single-ring plates for bone screw anchorage. On the anterior mandible, a double-level distraction by vertical osteotomy at the symphysis basal bone level for immediate widening, connected with a stepwise osteotomy up to the alveolar bone at the osteotomy site, between the lateral incisor and canine, was performed. An acrylic device with a curved jackscrew, designed to ensure precise curved alveolar bone distraction while preserving intercondylar distance, was secured with dental wire ligatures. Postoperative evaluation revealed no complications. The present case suggests that the technique may be applied to address transverse mandibular deficiency. Within the limitations of a single case report, this approach appears to be technically feasible and may represent a promising modification of previously described techniques. Further studies are required to assess reproducibility and clinical outcomes.